Lessons Learned from History and Experience: Five Simple Ways to Improve the Efficacy of Sexual Offender Treatment

Article excerpt

When I was asked to write an article in response to the questions, "Where has the field of Adult Sexual Offender Treatment come from?," "What have you learned through your experience in this field?," and "Where do you think the field is headed?" I was pleased because these questions reflect the historical and personal contemplative approach that guides my own professional development. Indeed, among the principal lessons of our collective journey toward reducing the prevalence of sexual abuse is the indispensable value of a long-lensed perspective that takes in both the history of events and ideas, as well as the experience of those who have walked before and alongside. Absent a commitment to self-reflection as individual professionals and as a field, our solutions will merely be unhelpful reactions and re-enactments to the powerful phenomenon of abuse to which we delve. Embedded in the questions Phil Rich poses to our field in organizing this special journal issue is the valuable reminder that even as healers we can get lured into the cycle of abuse and unintentionally promote solutions that beget further problems.

* The History of Sexual Offender Treatment in the United States

In the United States, Sexual Offense Specific Treatment emerged as a unique branch of psychotherapy in the 1980s alongside the momentum of the Women's Movement (D'Orazio, Arkowitz, Adams, & Maram, 2009). For the first time in national history, societal attention focused on the problem of abuse against women and children perpetrated by men. Rising from the knowledge that the extant sociopolitical culture had been suppressing the reporting, arrest, and conviction of crimes of abuse upon women and children, there was a spring-like blossom of criminal justice sanctions for sexual offending. Penal codes criminalizing sexual abuse expanded exponentially, rates of detected sexual offending skyrocketed, and the sexual offender inmate population soared.

Psychiatric facilities that had theretofore primarily treated the psychotically mentally ill found themselves accommodating burgeoning rates of paraphilic and personality disordered patients. The "newly discovered" social malady triggered a pressing demand within criminal and civil justice systems for large-scale treatment programs. Born out of a too long ignored social problem, Sexual Offender Treatment represented a component of justice for a victimized class.

Relapse Prevention (RP) treatment was developed in the 1980s in the substance abuse field by Marlatt and Gordon (1985) who promoted the idea of addiction as a byproduct of social learning as opposed to being a type of biological disease. The RP approach sought to address the problem of maintaining abstinence after treatment; despite initial success in overcoming substance abuse, 80% of substance abusers seemingly fell prey to beliefs they were afflicted and powerless by addiction, and relapsed within just 12-months of treatment (Hunt, Barnett, & Branch, 1971). Central to RP is the theory of a Relapse Cycle where relapse is the result of small knowable events that occur over time rather than in an all or nothing and uncontrollable manner. RP's premise is that abstinence is empowered by the identification of risk factors that drive the abuser toward re-lapse and self-management strategies to avoid or cope with these risks.

As the pendulum of psychotherapeutic popularity swung from psychoanalysis to behaviorism, landing in the 1980s on Cognitive Behavioral Therapy (CBT), pioneers like Gene Abel and Judith Becker popularized CBT as the method of choice for everyone who was anyone in the field of sexual abuse treatment. In an effort to resolve the problem of an exploding sexual offender population at California's Atascadero State Hospital (ASH), an emerging psychologist, Janice Marques, attempted to crossbreed the two applications of abuse treatment--the RP approach of the substance abuse field and CBT. …